Provider Demographics
NPI:1407007412
Name:JONES, BRENNON GARY (PA-C)
Entity Type:Individual
Prefix:MR
First Name:BRENNON
Middle Name:GARY
Last Name:JONES
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1173 S 250 W STE 503
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-7190
Mailing Address - Country:US
Mailing Address - Phone:435-674-0217
Mailing Address - Fax:435-674-0059
Practice Address - Street 1:1173 S 250 W STE 503
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-7190
Practice Address - Country:US
Practice Address - Phone:435-674-0217
Practice Address - Fax:435-674-0059
Is Sole Proprietor?:No
Enumeration Date:2008-10-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4253363AM0700X
UT11918893-1206363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MJ1855280OtherDEA